Racial differences in patterns of clinical trial discussion and participation among breast cancer patients at the University of Chicago.
Authors: Jincong Q. Freeman, Nan Chen, Sudha Yarlagadda, Fangyuan Zhao, Dezheng Huo, Olufunmilayo I. Olopade, Rita Nanda
Journal: Journal of Clinical Oncology (2023)

e18540 Background: Racial disparities in breast cancer clinical trial enrollment exist and pose a significant barrier to providing equitable cancer care. Racial/ethnic minorities are often underrepresented in clinical trials, and an improved understanding of trial enrollment patterns is needed to improve access. At the University of Chicago (UC), 40% of breast cancer patients (pts) are of self-reported Black race. We surveyed pts to better understand patterns of clinical trial discussion and enrollment. Methods: From July-September 2022, we conducted a survey of pts enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Pts were asked a number of questions about clinical trials, including if they 1) sought care at UC with the intent to participate in a trial, 2) were offered participation in a trial, and 3) enrolled in a trial. We also explored barriers to trial enrollment. We assessed racial differences using multivariable logistic regression. Results: Of 1,150 respondents, the mean age was 53.7 years (SD = 11.9); 73.0% were White, 19.5% were Black, 4.4% were Asian, and 3.1% were Hispanic. Overall, 38.9% reported discussing a clinical trial with a provider during their visit, while only 4.9% reported their goal in coming to UC was to participate in a trial. Black pts were more likely than White pts to have had a trial discussion (46.4% vs. 36.9%; p= 0.01). However, after adjusting for stage and molecular subtype, no statistically significant differences in trial discussion between Black and White (adjusted odds ratios [AOR] = 1.33, 95%CI: 0.92-1.92), between Asian and White (AOR = 1.02, 95%CI: 0.51-2.02), or between Hispanic and White (AOR = 1.38, 95%CI: 0.62-3.06) pts were observed. Among pts who were offered a trial, 64.3% participated. While there were numerical differences in the proportion of trial participation across racial/ethnic groups (Hispanic 73.3%, White 66.2%, Black 60.8%, Asian 44.4%), these differences were not statistically significant ( p= 0.20). Among pts who did not participate in the trial offered, 10.8% reported being worried about the possibility of getting a placebo, 8.2% of possible side effects, and 8.2% of delays in treatment initiation. Conclusions: Across our diverse pt population, Black pts were most likely to have had a clinical trial discussion. This may be due to our focus on trials for advanced and/or triple-negative breast cancer, diagnoses that occur with greater frequency in Black pts treated at UC. Consistent with other studies, we demonstrated that when offered, Black pts are just as likely to participate in trials as White pts. These data provide valuable insights that can serve as a roadmap for how to expand access to trials for minority populations. Work is ongoing to better characterize the barriers that limit participation among our minority pts, to further enhance access to leading-edge clinical trials across the UC network.